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� 3z �s�''c �. <br />PROJECT ADDRESS <br />L�nca/1 <br />ownor <br />ELECTRICAL PERIIlfIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -www.everettwa.org 7` � `�b <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���0!� �` <br />S � � J«�1i GJ� <br />L�i " �3 <br />es. l��I C-�����_� <br />Mall�ddross <br />Ci1y <br />u <br />1��.9�Z7u 36C G54-/57 <br />Slate2lp <br />Phone <br />Er�; �< i-i��+ws I�r'i C' re,�c �� C�ii� M�Ylui �,i�(�- 4��. 9Az ��, �GO �ES'r �/$')c/ <br />Tenanl A1aill�ddress Cil� Slatc/Zlp Phono <br />[Icclrical ConUaclur nlail �Jdir.ss <br />✓-1 � q <br />E►, «.- 1� I� i y Ns �-��� - Z�. �� <br />Sfate Licnnsct Number <br />Proposed Use ol �u0ding <br />Descrip�ion ol Work lo Do Dnnc: L�✓I uP! <br />NOT[ VJIRING IN IJON-DWELLINGS IS REQUIRED TO <br />�E W RAC[WAYS, MC OR AC CA�LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />t' <br />Slate21p <br />Contract Prico ol Work <br />Conlacl Porson (Plan Roview� <br />u.� 1 i <br />I h�.rr.by c��rtdy fhaf I ha�r �ond FlnJ examined fhis npplicntion r�nJ know fho senm fo be fruo nnA <br />cormct. All provislous ollnn�s.�nd enlinnnces 9ovorning fhis fype ol �ti�ork will bo cornpl�feJ <br />v,hefher spccilieAhcrcin or noL Thu �ientinp o( n pr.�nuf docrs nof/vasuma to glvo aufho�ity fo <br />� rolate or cnncel fho Iuuvisions o/ anp ofher stafe or loud Inw rer�u nfing consl�uclion or fho <br />perlorrnonco o/ consliucfion. Th�if / nrn aufhoiized bp Iho o�ti�nor o/ fhis _ryoperty N�tt3rfomi fho <br />�soik lor �vhich applicalion is nindr and 1 compl}� wifh tho Sfate Conhnctors L��w It1.27 HCIN nnd <br />296 200 WAC. <br />l/L.��l �` �/ �-�: 1 1,�� ` — / �"� ��% <br />Sipnalure Uale -- <br />P[[ <br />� � �'t � r;'.� L <br />Phone <br />